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Editor,—Acquired rectovaginal fistula associated with HIV positive children is a new and rather curious entity.1 The underlying pathology has been reported to be chronic diarrhoea with abscess formation in the anterior rectal wall; after breakdown of the abscess, a persistent fistula appears.2 We have seen seven such infants with fistulae in the past three years. We treated all these eases with diversion sigmoid colostomy. Biopsy of the fistula confirmed the presence of chronic inflammatory cells only. Our result with colostomy has been disappointing, with no spontaneous healing so far.
We would like to point out that in all these cases the fistula tract was from the upper anal canal to the vestibule just posterior to the introitus, thus making this condition a rectovestibular fistula, rather than rectovaginal.
Furthermore although HIV is implicated in five of our cases, we also have had two cases of infant girls with this condition who were HIV negative on enzyme linked immunosorbent assay (ELISA) test. Their respective mothers also tested negative on ELISA testing. Curiously both of these children suffered from acute onset of diarrhoea one week before the fistula appearance. No causative organisms were grown from their stool cultures. If one is to take account of these two cases, rectovestibular fistula may be caused by a specific but as yet undescribed organism, which is more prevalent in HIV positive infants.
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